Beta-Tricalcium Phosphate Brands: Synthograft

Beta-Tricalcium Beta-Tricalcium PhosphatePhosphate

BrandsBrands

11SynthograftSynthograft

22CerasorbCerasorb

33GraftekGraftek

Completely unique and synthetic GEM 21Sreg is an innovative combination of a bioactive protein (highly purified recombinant human platelet derived growth factor rhPDGF-BB) and a biocompatible osteoconductive matrix (beta-tricalcium phosphate β-TCP)GEM 21Sreg contains 1000x more active growth factor (PDGF) than found in platelet rich plasma Compared to bone graft substitute without PDGFProvides 3x more bone fill at 6 monthsProvides a more predictable treatment option even in the most severe cases


ldquoldquoSockets with intact buccal and lingual Sockets with intact buccal and lingual plates heal well without graftinghellip plates heal well without graftinghellip consider grafting with resorbable consider grafting with resorbable osteoinductive material if plates osteoinductive material if plates compromised and implants plannedrdquo compromised and implants plannedrdquo grafting with connective tissue if pontic grafting with connective tissue if pontic esthetics an issuerdquoesthetics an issuerdquo


Vital Root RetentionVital Root RetentionbullNever our first choice but an option for

preserving alveolar bone when performing full mouth extractions on young patients

bullTeeth must be vital with good periodontal health

bullSimilar tooth selection as ldquoconventionalrdquo overdentures except elective endodontics not performed

bullNever our first choice but an option for preserving alveolar bone when performing full mouth extractions on young patients



Vital Root RetentionVital Root RetentionbullAmputate teeth at crest then remove 2

mm more tooth ldquosub osseousrdquo

bullConsider grafting autogenous bone over tooth then close primarily

bullIdeally bone grows coronally over a vital asymptomatic root

bullDepending on rate of alveolar resorption will help preserve ridge 3-5 years before exposureextraction

bullAmputate teeth at crest then remove 2 mm more tooth ldquosub osseousrdquo




Remove 2 mm tooth structure below bone

2 mm

Suture

New Bone Prosthesis

J Oral Maxillofac SurgJ Oral Maxillofac Surg 2005 Feb43(1)7-12 A 2005 Feb43(1)7-12 A randomized controlled clinical trial to randomized controlled clinical trial to compare the incidence of injury to the compare the incidence of injury to the inferior alveolar nerve as a result of inferior alveolar nerve as a result of coronectomy and removal of mandibular third coronectomy and removal of mandibular third molars Renton T Hankins M Sproate Cmolars Renton T Hankins M Sproate C

bull The length of follow up was about two The length of follow up was about two years which for the assessment of years which for the assessment of delayed eruption of the root fragments delayed eruption of the root fragments is not sufficient as this process may is not sufficient as this process may continue for up to 10 years However continue for up to 10 years However it seems that coronectomy reduces the it seems that coronectomy reduces the incidence of injury to the inferior incidence of injury to the inferior alveolar nerve without increasing the alveolar nerve without increasing the risk of dry socket or infection risk of dry socket or infection

J Oral Maxillofac Surg 2004 Dec62(12)1447-52 Coronectomy a technique to protect the inferior alveolar nerve Pogrel MA Lee JS Muff DF


PURPOSE Damage to the inferior alveolar nerve when extracting lower third molars is often caused by the intimate relationship between the nerve and the roots of the teeth The technique of coronectomy or intentional root retention may minimize this problem

PURPOSE Damage to the inferior alveolar nerve when extracting lower third molars is often caused by the intimate relationship between the nerve and the roots of the teeth The technique of coronectomy or intentional root retention may minimize this problemRESULTS There were no cases of inferior alveolar nerve-involved damage in this study of 41 patients who underwent 50 coronectomies There was 1 case of transient lingual nerve involvement probably from the use of the lingual retractor One patient required subsequent removal of the roots of both lower third molars because of failure to heal and 1 patient required subsequent removal of a root because of subsequent migration to the surface Root migration was noted in approximately 30 of patients over a 6 month period CONCLUSION Coronectomy appears to be a viable technique in those cases where removal of the whole tooth might put the inferior alveolar nerve at considerable risk of damage

RESULTS There were no cases of inferior alveolar nerve-involved damage in this study of 41 patients who underwent 50 coronectomies There was 1 case of transient lingual nerve involvement probably from the use of the lingual retractor One patient required subsequent removal of the roots of both lower third molars because of failure to heal and 1 patient required subsequent removal of a root because of subsequent migration to the surface Root migration was noted in approximately 30 of patients over a 6 month period CONCLUSION Coronectomy appears to be a viable technique in those cases where removal of the whole tooth might put the inferior alveolar nerve at considerable risk of damage

Pre-op (Oral Pre-op (Oral bisphosphonates X bisphosphonates X 5 years)5 years)

Immed Immed PostPost

10 month 10 month postpost

Immediate Implant Placement Following

Extractions


ExtractionsbullNeed 3-4 mm of solid bone at base

of socket and no active infection

bullSuccess rates ~ to ldquonormalrdquo

bullMost typical sites anterior teeth and 1st premolars

bullAdvantages May reduce loss of labial plate and improve esthetics as well as save time

bullNeed 3-4 mm of solid bone at base of socket and no active infection




Platelet Rich PlasmaPlatelet Rich PlasmaPlatelet Rich PlasmaPlatelet Rich PlasmabullWhatrsquos HotWhatrsquos Hot

ndash Release various Release various growth factors that growth factors that aid in hemostasis aid in hemostasis and increase rate and increase rate of healing of healing (mitogenesis (mitogenesis angiogenesis) angiogenesis)

bullWhatrsquos HotWhatrsquos Hotndash Release various Release various

growth factors that growth factors that aid in hemostasis aid in hemostasis and increase rate and increase rate of healing of healing (mitogenesis (mitogenesis angiogenesis) angiogenesis)

bullWhatrsquos NotWhatrsquos Notndash CostCostndash Is there any Is there any

difference at 6 difference at 6 weeksweeks

ndash Invasive Invasive borrow 45-borrow 45-90ml of blood90ml of blood




Casap et al Immediate Implantation Into Debrided Infected Sockets J Oral Maxillofac Surg 2007

Does placing implants into fresh extraction Does placing implants into fresh extraction sockets preserve bonesockets preserve bone

J Clin Periodontol 2005 Jun32(6)645-52 Ridge alterations following implant placement in fresh extraction sockets an experimental study in the dogArauacutejo MG Sukekava F Wennstroumlm JL Lindhe J

CONCLUSIONS Marked dimensional alterations had occurred in the edentulous ridge after 3 months of healing following the extraction of the distal root of mandibular pre-molars The placement of an The placement of an implant in the fresh extraction site obviously implant in the fresh extraction site obviously failed to prevent the re-modeling that occurred failed to prevent the re-modeling that occurred in the walls of the socketin the walls of the socket The resulting height of the buccal and lingual walls at 3 months was similar at implants and edentulous sites

Most human trials however reveal results Most human trials however reveal results similar to implants place via the ldquoold similar to implants place via the ldquoold schoolrdquo approach even when immediately schoolrdquo approach even when immediately loaded (caution in ldquosoftrdquo bone gt55 YO)loaded (caution in ldquosoftrdquo bone gt55 YO)

Int J Oral Maxillofac Implants 2007 Mar-Apr22(2)187-94 The radiographic bone loss pattern adjacent to immediately placed immediately loaded implantsJaffin R Kolesar M Kumar A Ishikawa S Fiorellini J

J Craniofac Surg 2007 Jul18(4)965-71 Immediate loaded dental implants comparison between fixtures inserted in postextractive and healed bone sitesDegidi M Piattelli A Carinci F

J Periodontol 2007 May78(5)810-5 Vertical crestal bone changes around implants placed into fresh extraction socketsCovani U Cornelini R Barone A

Why ReconstructWhy Reconstruct

bullNot enough bone for implants

bullEnough bone but esthetic result suboptimal

bullPrevent pathologic fracture

bullPoor functionestheticsretention of conventional removable prosthesis





How Autogenous Bone Grafts

with Implants


with Implants

Autogenous Block GraftsAutogenous Block Grafts

bullldquoGold Standardrdquo

bullOsteoinductive and Osteoconductive

bullNo need for membranes

bullHolds form

bullRemodels into 100 high quality bone

bullNo concerns about transmissible diseases




bullHolds form



Autogenous Block Grafts


bullDonor site morbidity

bullQuantity is limited

bullLose 20-30 during healing




Intra-oral Autogenous Bone Sites

AllogenicAllogenic Block Block GraftGraft

What about membranesWhat about membranes

bullUseful in containing particulate grafts

bullUseful around teethexposed implant threads

bullAdd expense

bull Infection risk

bullUnnecessary with block grafts

bullADA 4266 Resorbable

bullADA 4267 Non-Resorbable



bullAdd expense

bull Infection risk




Bone Morphogenic Protein (BMP)


bullGrow bone at will

bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects

bullStudies show excellent results for socket preservation sinus lifts

bullExpensive ($500000 for a sinus)





FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006

FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006 INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures

INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures

Distraction OsteogenesisDistraction

OsteogenesisbullGeneration of bone (and soft

tissue) through distraction of an osseous callus

bullGeneration of bone (and soft tissue) through distraction of an osseous callus

Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C


Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair


Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of


bull 3rd molars in function3rd molars in function

bull Lone standing molarsLone standing molars

bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns

bull 3rd molars + post-menopausal women3rd molars + post-menopausal women

bull Prior TMD historyPrior TMD history

bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience

bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity








3rd Molar Surgery ndash Why


1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin


Extract 3rds OralSystemic Extract 3rds OralSystemic LinkLink

CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women


A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology


Journal of Oral and Maxillofacial Journal of Oral and Maxillofacial SurgerySurgery

Volume 65 Issue 3 March 2007 Pages Volume 65 Issue 3 March 2007 Pages 377-383377-383

Progress Report on Third Molar Clinical Trials Progress Report on Third Molar Clinical Trials Raymond P White Jr DDS PhDRaymond P White Jr DDS PhD

1What happens to asymptomatic patients who keep their 1What happens to asymptomatic patients who keep their third molars third molars

2What is the recovery like for those who have them 2What is the recovery like for those who have them removed and what can we do as surgeons to improve removed and what can we do as surgeons to improve post operative outcomespost operative outcomes

3rd Molar Surgery ndash When3rd Molar Surgery ndash WhenbullBefore roots 100 developed

bullAfter roots 13 formed

bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated

bullDonrsquot forget tooth transplanttooth transplant if apex not closed

bullBefore roots 100 developed




Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth


3rd Molar Surgery ndash When Not


bullExtremes of age

bullNo oral communication (full bony)

bullIntimate root-nerve Relationship

bullRisks gt Benefits

bullExtremes of age




3rd Molar Surgery Alternatives


bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years


No High SpeedNo High Speed

bullAir embolus

bullAir emphysema

bullBlow debris into flap

bullBlow bacteria into flap

bullNon-sterile water

bullAir embolus

bullAir emphysema




Which are trueWhich are true1 Tooth transplants are usually done on

patients 20-302 Average success rate for a tooth

transplant is 20-303 In order to work a transplant must

have endo4 Most transplants will ankylose

A 13 B 24 C 123 D 3 only

E None of the above

1 Tooth transplants are usually done on patients 20-30

2 Average success rate for a tooth transplant is 20-30

3 In order to work a transplant must have endo

4 Most transplants will ankylose

A 13 B 24 C 123 D 3 only

E None of the above

How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the

inferior alveolar nerveinferior alveolar nerve

Slide 2

Slide 3

Slide 4

ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo

Vital Root Retention

Slide 7

Slide 8

Slide 9

J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C

Slide 11

Slide 12

Immediate Implant Placement Following Extractions

Platelet Rich Plasma

Slide 15

Slide 16

Slide 17

Why Reconstruct

How Autogenous Bone Grafts with Implants


Slide 21


Slide 23

What about membranes


Slide 26

Distraction Osteogenesis

Slide 28

Wise Old Oral Surgeon Says Beware of


Extract 3rds OralSystemic Link

Slide 32

3rd Molar Surgery ndash When



No High Speed

Slide 38

Which are true

Slide 40






















2 mm

Suture

New Bone Prosthesis












Extractions







































with Implants


with Implants





bullHolds form






bullHolds form
















bullAdd expense

bull Infection risk






bullAdd expense

bull Infection risk



































































bullExtremes of age




bullExtremes of age









bullAir embolus

bullAir emphysema




bullAir embolus

bullAir emphysema








A 13 B 24 C 123 D 3 only

E None of the above





A 13 B 24 C 123 D 3 only

E None of the above



Slide 2

Slide 3

Slide 4



Slide 7

Slide 8

Slide 9


Slide 11

Slide 12



Slide 15

Slide 16

Slide 17

Why Reconstruct



Slide 21


Slide 23



Slide 26


Slide 28




Slide 32




No High Speed

Slide 38

Which are true

Slide 40

New Bone Prosthesis












Extractions







































with Implants


with Implants





bullHolds form






bullHolds form
















bullAdd expense

bull Infection risk






bullAdd expense

bull Infection risk



































































bullExtremes of age




bullExtremes of age









bullAir embolus

bullAir emphysema




bullAir embolus

bullAir emphysema








A 13 B 24 C 123 D 3 only

E None of the above





A 13 B 24 C 123 D 3 only

E None of the above



Slide 2

Slide 3

Slide 4



Slide 7

Slide 8

Slide 9


Slide 11

Slide 12



Slide 15

Slide 16

Slide 17

Why Reconstruct



Slide 21


Slide 23



Slide 26


Slide 28




Slide 32




No High Speed

Slide 38

Which are true

Slide 40












Extractions







































with Implants


with Implants





bullHolds form






bullHolds form
















bullAdd expense

bull Infection risk






bullAdd expense

bull Infection risk



































































bullExtremes of age




bullExtremes of age









bullAir embolus

bullAir emphysema




bullAir embolus

bullAir emphysema








A 13 B 24 C 123 D 3 only

E None of the above





A 13 B 24 C 123 D 3 only

E None of the above



Slide 2

Slide 3

Slide 4



Slide 7

Slide 8

Slide 9


Slide 11

Slide 12



Slide 15

Slide 16

Slide 17

Why Reconstruct



Slide 21


Slide 23



Slide 26


Slide 28




Slide 32




No High Speed

Slide 38

Which are true

Slide 40





























with Implants


with Implants





bullHolds form






bullHolds form
















bullAdd expense

bull Infection risk






bullAdd expense

bull Infection risk



































































bullExtremes of age




bullExtremes of age









bullAir embolus

bullAir emphysema




bullAir embolus

bullAir emphysema








A 13 B 24 C 123 D 3 only

E None of the above





A 13 B 24 C 123 D 3 only

E None of the above



Slide 2

Slide 3

Slide 4



Slide 7

Slide 8

Slide 9


Slide 11

Slide 12



Slide 15

Slide 16

Slide 17

Why Reconstruct



Slide 21


Slide 23



Slide 26


Slide 28




Slide 32




No High Speed

Slide 38

Which are true

Slide 40





bullHolds form






bullHolds form
















bullAdd expense

bull Infection risk






bullAdd expense

bull Infection risk



































































bullExtremes of age




bullExtremes of age









bullAir embolus

bullAir emphysema




bullAir embolus

bullAir emphysema








A 13 B 24 C 123 D 3 only

E None of the above





A 13 B 24 C 123 D 3 only

E None of the above



Slide 2

Slide 3

Slide 4



Slide 7

Slide 8

Slide 9


Slide 11

Slide 12



Slide 15

Slide 16

Slide 17

Why Reconstruct



Slide 21


Slide 23



Slide 26


Slide 28




Slide 32




No High Speed

Slide 38

Which are true

Slide 40














bullAdd expense

bull Infection risk






bullAdd expense

bull Infection risk



































































bullExtremes of age




bullExtremes of age









bullAir embolus

bullAir emphysema




bullAir embolus

bullAir emphysema








A 13 B 24 C 123 D 3 only

E None of the above





A 13 B 24 C 123 D 3 only

E None of the above



Slide 2

Slide 3

Slide 4



Slide 7

Slide 8

Slide 9


Slide 11

Slide 12



Slide 15

Slide 16

Slide 17

Why Reconstruct



Slide 21


Slide 23



Slide 26


Slide 28




Slide 32




No High Speed

Slide 38

Which are true

Slide 40
































































bullExtremes of age




bullExtremes of age









bullAir embolus

bullAir emphysema




bullAir embolus

bullAir emphysema








A 13 B 24 C 123 D 3 only

E None of the above





A 13 B 24 C 123 D 3 only

E None of the above



Slide 2

Slide 3

Slide 4



Slide 7

Slide 8

Slide 9


Slide 11

Slide 12



Slide 15

Slide 16

Slide 17

Why Reconstruct



Slide 21


Slide 23



Slide 26


Slide 28




Slide 32




No High Speed

Slide 38

Which are true

Slide 40






bullAir embolus

bullAir emphysema




bullAir embolus

bullAir emphysema








A 13 B 24 C 123 D 3 only

E None of the above





A 13 B 24 C 123 D 3 only

E None of the above



Slide 2

Slide 3

Slide 4



Slide 7

Slide 8

Slide 9


Slide 11

Slide 12



Slide 15

Slide 16

Slide 17

Why Reconstruct



Slide 21


Slide 23



Slide 26


Slide 28




Slide 32




No High Speed

Slide 38

Which are true

Slide 40





A 13 B 24 C 123 D 3 only

E None of the above





A 13 B 24 C 123 D 3 only

E None of the above



Slide 2

Slide 3

Slide 4



Slide 7

Slide 8

Slide 9


Slide 11

Slide 12



Slide 15

Slide 16

Slide 17

Why Reconstruct



Slide 21


Slide 23



Slide 26


Slide 28




Slide 32




No High Speed

Slide 38

Which are true

Slide 40



Slide 2

Slide 3

Slide 4



Slide 7

Slide 8

Slide 9


Slide 11

Slide 12



Slide 15

Slide 16

Slide 17

Why Reconstruct



Slide 21


Slide 23



Slide 26


Slide 28




Slide 32




No High Speed

Slide 38

Which are true

Slide 40

Beta-Tricalcium Phosphate Brands: Synthograft

Documents

Transcript of Beta-Tricalcium Phosphate Brands: Synthograft